MEDICARE: ANDREW GREGORY ANASTASIA PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	051301445	IL
2	183500000X	Pharmacist	18210	OR

General Provider Information

NPI Number	:	1629671813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW GREGORY ANASTASIA PHARMD

Provider Business Mailing Address
First Line	:	5681 NE GLISAN ST UNIT 12
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-3463
Country	:	US
Telephone Number	:	847-533-1669
Fax Number	:

Provider Business Practice Location Address
First Line	:	6901 SE SANDY BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-9721
Country	:	US
Telephone Number	:	503-280-1212
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2020
Last Update Date	:	03/07/2023

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